President's Message

august 2020

Collateral Cardiovascular Injury from School Closures

Dear Maryland ACC Colleagues,

I vividly recall the shock I received in my first month of medical school in 1988 attending a small group seminar led by a leader of the Kaiser Family Foundation, a leader in the nascent field of population health. His thesis was that educational achievement was far more predictive of the health of a population than access to medical care. If we really cared about improving the health of our patients, he argued, we had chosen the wrong field. Huh? I challenged him with personal anecdotes of family members who had benefited from modern medical and surgical care. All well and good, he gently responded, but at a population level, education matters more. Others have made the same argument.

This anecdote illustrates the profound consequences of decisions now being made regarding opening of public schools in the fall. Many large school districts around the country and almost all in Maryland have announced that they will not open for in-person classes in the fall. Given that Covid-19 shows no signs of disappearing, and may even surge again in the winter, a decision to close schools in September likely represents a decision to close for the academic year.

These decisions will have at least three major consequences that the ACC and its members will need to consider for the future:

• Effect on health care disparities. Students in disadvantaged minority communities are more likely to rely on public schools, less likely to have access to broadband internet and computer technology, and less likely to engage in “distance learning”. In the spring, some urban school districts reported less than half of students engaging in distance learning at all, while the level of engagement and learning in those logging on is difficult to assess.  Prolonged school closures are therefore likely to widen the education achievement gap between more and less affluent public school students, as well as the gap between private and public school students. Research into social determinants of health indicate that these widening educational achievement gaps will almost certainly result in widening health care disparities in the years ahead. The ACC has committed itself to working to improve health disparities as part of its Diversity and Inclusion initiative and its response to national protests against structural racism. Prolonged school closures will make this challenge much greater.
• Effect on “deep pipeline” of under-represented minorities in the health professions. A major goal of the ACC Diversity and Inclusion initiative is to increase numbers of people who have been under-represented in cardiology (URC). Strategies to increase the number of African-Americans in medicine have recognized the need improve the “deep pipeline” into medicine. While African-Americans make up 13% of the US population, they represent only 6% of medical school graduates. Prolonged school closures will make improving these numbers even more challenging.
• Effect on ACC member well-being. A recent Washington Post article highlighted the challenge working parents in health care faced last spring, managing work, child care, and keeping students on task with “distance learning”. This burden has fallen disproportionately on women and threatens to worsen concerning trendlines in clinician burnout and well-being. ACC has made important commitments to improve clinician well-being. School closures will require adding another dimension to this endeavor.

Several major organizations have emphasized the importance of open schools for student well-being and public health. Let us hope that creating the conditions for this to happen becomes the highest national priority.

On the Advocacy front, the ACC has been at work preparing for the next big coronavirus relief package being considered by Congress. ACC’s President, Dr. Athena Poppas, recently submitted a letter outlining ACC member priorities for consideration, including:

• Ensuring stability of medical practices of all sizes and types. Cardiology practices are part of America’s essential health care infrastructure.
• Improving access to telehealth. This has become a critical service to maintain patient access to care and for practice financial viability.
• Access to personal protective equipment. This is particularly important as we face a potential second wave of the epidemic in the late fall and winter.
• Improved access to testing and turnaround time. This step will be essential to bringing the epidemic under control.
• Additional liability protections during the Public Health Emergency. Clinicians have been asked by government to respond to the PHE by making extraordinary changes in how we practice. We should not be penalized for doing so.
• Prior authorization. The epidemic has placed great stress on cardiology practices. Relief of this administrative burden is low-hanging fruit.
• Deferring administrative programs, such as Quality Payment Program (QPP) and the AUC mandate, that may divert critical clinician time and energy from providing patient care during the pandemic.

All ACC members are asked to contact our Congressional representative to support these priorities. Take action today!

Sincerely,